Implementing and sustaining an evidence-based nutrition service in a haematology unit for autologous stem cell transplant patients
Effective, timely and evidence-based nutritional management is important in patients receiving autologous haematopoietic stem cell transplant (HSCT) to prevent the negative consequences of developing malnutrition. This study describes a robust process for development and implementation of an evidence-based nutrition care pathway for HSCT patients in a tertiary cancer centre.
A comprehensive review of the literature was completed to identify relevant articles and evidence-based guidelines to inform the development of the pathway. Evidence from the literature review was assessed and utilised to underpin the development of pathway. The pathway was implemented in the haematology service in collaboration with the multidisciplinary haematology team. Dietetic resource requirements for implementation of the pathway were determined and clinician compliance with the care pathway was assessed to evaluate the feasibility of the pathway in supporting delivery of evidence-based care.
The evidence-based care pathway was implemented in 2011 with the final care pathway based on recommendations from five international evidence-based guidelines. Overall clinician compliance with delivering nutrition management described in the care pathway was high at 84%. The dietetic resource requirement for implementation of the care pathway was 300 to 400 h per 100 patients depending on conditioning chemotherapy regimen.
A robust process for developing and implementing a nutrition care pathway for HSCT patients was effective in supporting the delivery of evidence-based nutritional management for patients treated with HSCT.
KeywordsNutrition Haematology Autologous stem cell transplant Care pathway
The authors would like to thank the multidisciplinary haematology team for their support with the development and implementation of the care pathway. No funding was received to complete this work.
All authors have made substantial contributions to the design of the study, collection or interpretation of data and writing the manuscript.
Compliance with ethical standards
Conflict of interest
None to declare.
- 1.International Agency for Research on Cancer (IARC). GLOBOCAN 2012 v1.1 Cancer Incidence and Mortality Worldwide. IARC CancerBase No.11 2012 8th January 2018]; Available from: http://globocan.iarc.fr
- 2.Leukaemia Foundation. Leukaemia Foundation Homepage. [cited 2017 20th November]; Available from: http://www.leukaemia.org.au
- 3.Sonis ST, Oster G, Fuchs H, Bellm L, Bradford WZ, Edelsberg J, Hayden V, Eilers J, Epstein JB, LeVeque FG, Miller C, Peterson DE, Schubert MM, Spijkervet FKL, Horowitz M (2001) Oral Mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol 19(8):2201–2205CrossRefPubMedGoogle Scholar
- 6.Pressoir M, Desné S, Berchery D, Rossignol G, Poiree B, Meslier M, Traversier S, Vittot M, Simon M, Gekiere JP, Meuric J, Serot F, Falewee MN, Rodrigues I, Senesse P, Vasson MP, Chelle F, Maget B, Antoun S, Bachmann P (2010) Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 102(6):966–971CrossRefPubMedGoogle Scholar
- 7.Hung Y-C, Bauer J, Horsley P, Waterhouse M, Bashford J, Isenring E (2013) Changes in nutritional status, body composition, quality of life, and physical activity levels of cancer patients undergoing autologous peripheral blood stem cell transplantation. Support Care Cancer 21(6):1579–1586CrossRefPubMedGoogle Scholar
- 8.Dickson TMC, Kusnierz-Glaz CR, Blume KG, Negrin RS, Hu WW, Shizuru JA, Johnston LL, Wong RM, Stockerl-Goldstein KE (1999) Impact of admission body weight and chemotherapy dose adjustment on the outcome of autologous bone marrow transplantation. Biol Blood Marrow Transplant 5(5):299–305CrossRefPubMedGoogle Scholar
- 10.Raynard B, Nitenberg G, Gory-Delabaere G, Bourhis JH, Bachmann P, Bensadoun RJ, Desport JC, Kere D, Schneider S, Senesse P, Bordigoni P, Dieu L (2003) Summary of the standards, options and recommendations for nutritional support in patients undergoing bone marrow transplantation. Br J Cancer 89(Suppl 1):S101–S106CrossRefPubMedGoogle Scholar
- 14.Hughes BGM, Jain VK, Brown T, Spurgin A-L, Hartnett G, Keller J, Tripcony L, Appleyard M, Hodge R (2013) Decreased hospital stay and significant cost savings after routine use of prophylactic gastrostomy for high-risk patients with head and neck cancer receiving chemoradiotherapy at a tertiary cancer institution. Head Neck 35(3):436–442CrossRefPubMedGoogle Scholar
- 17.National Health and Medical Research Council (2009) NHMRC Levels of Evidence and Grades for Recommendations for Developers of Guidelines. Available from: http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/evidence_statement_form.pdf
- 20.Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, van Bokhorst-de van der Schueren MAE, von Meyenfeldt M, Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom HJ, Zander A (2006) ESPEN guidelines on enteral nutrition: non-surgical oncology. Clin Nutr 25(2):245–259CrossRefPubMedGoogle Scholar
- 23.Isenring E, Zabel R, Bannister M, Brown T, Findlay M, Kiss N, Loeliger J, Johnstone C, Camilleri B, Davidson W, Hill J, Bauer J (2013) Updated evidence-based practice guidelines for the nutritional management of patients receiving radiation therapy and/or chemotherapy. Nutr Diet 70(4):312–324CrossRefGoogle Scholar
- 29.Botti S, Liptrott SJ, Gargiulo G, Orlando L (2015) Nutritional support in patients undergoing haematopoietic stem cell transplantation: a multicentre survey of the Gruppo Italiano Trapianto Midollo Osseo (GITMO) transplant programmes. ecancermedicalscience 9: 545Google Scholar
- 32.Murray SM, Pindoria S (2009) Nutrition support for bone marrow transplant patients. Cochrane Database Syst RevGoogle Scholar